The Office of the National Coordinator for Health Information Technology Health IT Playbook

Section 1

Electronic Health Records

Which phase of the EHR adoption process are you currently in?

The United States has experienced a tremendous increase in electronic health record (EHR) adoption due to the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program.

EHRs — real-time, patient-centered records — make health information available instantly and securely to authorized users whenever and wherever they need them. EHRs can help you:

  • Streamline your workplace
  • Improve quality of care
  • Update information easily
  • Exchange data with other care providers

EHR adoption offers great potential, but it also presents challenges to clinical organizations undergoing the transition. That’s true whether you’re moving from a paper-based system or from another EHR.

The EHR journey

Most clinicians agree that implementing an EHR is an ongoing journey. There is no single destination or end, as there’s always the opportunity to optimize workflows or improve the use of data. This section provides resources to guide you through the many stops along the road to EHR adoption and implementation. These include:

  • Planning
  • Selecting a vendor
  • Contracting with a vendor
  • Implementing and adopting an EHR
  • Using your EHR
  • Optimizing or replacing your EHR

After you spend time using and getting familiar with your EHR, it’s time to think about how you can use your workflows to improve and optimize your EHR. This ongoing nature of the EHR journey starts each time you adopt additional health IT solutions, such as:

  • Adding a patient portal
  • Connecting to a health information exchange
  • Participating in value-based care or new payment models

The information in this Playbook reflects lessons learned from years of implementation experience across a wide variety of clinical settings. Navigate the Playbook and select the tools appropriate for your EHR adoption journey.

EHR Contracts Untangled: Selecting Wisely, Negotiating Terms, and Understanding the Fine Print

Selecting an electronic health record (EHR) and then negotiating its purchase is a challenge for any health care provider. The downloadable Electronic Health Records Contract Guide can help you, your business managers, and your advisors select the right technologies for your practice, and then navigate the acquisition process. It will also help you negotiate contract terms to minimize potential problems and to build a stronger relationship with your health IT vendor.

Upgrading your EHR? The EHR Contract Guide can also help you upgrade your current system to meet new certification requirements or to integrate new modules, capabilities, and services.

The EHR contract guide in 2 parts

Part A highlights critical planning steps to help you understand the EHR acquisition process. A thorough understanding will help you communicate your specific requirements to potential vendors. Topics include:

  • Types of EHR products and service models
  • Researching and comparing EHR products and vendors
  • Identifying and prioritizing your EHR’s technical and operational requirements
  • Due Diligence: Finding the best EHR for your needs
  • Understanding certification and regulatory requirements
  • Procurement strategy, planning, and resourcing

Part B focuses on negotiating and contracting, and it contains strategies and recommendations to negotiate best-practice EHR contract terms. The guide also provides example language to illustrate how you might address legal issues in a contract. Topics include:

  • EHR safety and security
  • How to ensure system performance meets expectations
  • How to manage and protect EHR data
  • Interoperability and integration
  • How to manage risk and liability
  • Vender-dispute resolution
  • How to manage EHR transition issues

Disclaimer

This document should not be construed as legal advice and does not address all possible legal and other issues that may arise with the acquisition of an EHR. Because every healthcare provider organization is unique with respect to its operations, priorities, resources and IT infrastructure, your purchase, implementation and use of an EHR will present issues specific to your practice or organization that cannot be contemplated or addressed in this guide. We strongly encourage you to obtain the advice of an experienced attorney whenever you are proposing to enter into a legally binding agreement for health IT products or services.

Electronic Health Records Contract Guide

EHR Contract Guide cover

Overview
Provides critical planning and negotiation steps to help you understand and communicate your EHR requirements; includes examples of contract language and technical terms

Who it’s for
Health care providers, business and office managers

When it’s used
To select an EHR and to negotiate the purchase

Download Electronic Health Records Contract Guide [PDF - 798 KB]

The decision to move to an electronic health record (EHR) system requires a lot of time and effort. Before you begin your implementation project, it’s important to understand the benefits that an EHR brings to your practice. It’s also important to set realistic expectations. Common roadblocks to successful adoption include:

  • Difficulty understanding your organization’s information needs
  • Uncertain costs
  • The intense effort required to identify and implement a system

How can you overcome implementation roadblocks? Gather as many of these success factors as possible:

  • Readiness
  • Eager personnel
  • Someone to champion the cause
  • Stakeholders who perceive EHRs as useful
  • Teamwork

Remember: Your planning must address both the initial and the ongoing effects that EHR implementation will have on your clinical practice.

Cloud-based EHRs

Cloud-computing platforms provide scalable, on-demand access to IT services. The cloud can help you rapidly provision and launch an EHR system while minimizing management effort and cost. However, it’s important to thoroughly understand the benefits and challenges associated with a cloud-based EHR.

Reduce your risk!

Use legal contracts, appropriate service level agreements with your cloud provider, and on-going monitoring

Common benefits:

  • Reduces upfront hardware and software costs
  • Reduces on-going maintenance costs
  • Lets you start small and increase IT allocations as needed
  • Provides higher levels of IT-service availability than in-house IT services
  • Reduces run-time failures

Common challenges:

  • Data security — you and your cloud provider share responsibility
  • You have a lower level of data access and control compared to an on-site EHR system

Choosing an EHR system takes planning and a systematic decision-making approach. Understanding your practice’s needs and the capabilities of the various EHR systems on the market will help you find a system that meets your needs.



Learn more about the basics of EHR systems. The following resources are designed to help you select and test EHRs. The tools will help you:

  • Assess your readiness
  • Create a leadership team
  • Set goals to assist your decision-making process
  • Compare and select vendors
  • Choose the right system for your practice

EHR Demonstration Scenario, Evaluation, and Vendor Questions

EHR Selection Education cover

Overview
Provides established scenarios to help providers and health IT implementers understand vendor capabilities

Who it’s for
Providers and health IT implementers

When it’s used
To select, or upgrade to, a certified EHR vendor

Download EHR Demonstration Scenario, Evaluation, and Vendor Questions [PDF - 602 KB]

EHR Selection Education

Vendor Comparison Tool cover

Overview
Provides information about choosing an EHR system; defines common IT terms and discusses hardware and software considerations

Who it’s for
Providers, health IT implementers

When it’s used
To help you select or upgrade an EHR

Download EHR Selection Education [PDF - 742 KB]

EHR Selection Tool

Overview
Helps providers and health IT implementers select EHR functionalities from 10 major categories. Web-based tools include an interactive guide, case studies, definitions, and an EHR-selection matrix

Who it’s for
Providers and health IT implementers

When it’s used
To plan, select, and implement an EHR in long-term and post-acute care settings

Visit the LeadingAge EHR Selection Tool website

EHR System Testing Plan

EHR System Testing Plan cover

Overview
Helps you track various EHR performance tests

Who it’s for
Providers and health IT implementers

When it’s used
To track various EHR vendor systems during the selection process and to learn how each one works

Download EHR System Testing Plan [PDF - 533 KB]

Learn more about the basics of EHR systems. The following resources will help you compare vendors and pricing.

Vendor Comparison Tool

Vendor Comparison Tool cover

Overview
Suggests questions to ask EHR vendors during demos — including how their systems meet Meaningful Use objectives

Who it’s for
Providers, practice managers, and health IT implementers

When it’s used
To research and select an EHR system

Download Vendor Comparison Tool [PDF - 336 KB]

Vendor Pricing Template

Vendor Pricing Template

Overview
Defines line-item costs for EHR software, implementation, training, and support — for both on-site licensing models and cloud-based platforms. Helps you compare costs among prospective vendors

Who it’s for
EHR implementation lead, practice manager, and finance lead

When it’s used
To research, select, and contract EHRs

Download Vendor Pricing Template [XLSX - 102 KB]

A successful EHR implementation consists of 2 phases: pre-implementation and implementation. Following these guidelines will help you get the most out of your system. During the pre-implementation phase you:

  • Establish a governance process and a project plan
  • Communicate with and involve staff and patients
  • Redesign workflows
  • Provide education and training

During the implementation phase you:

  • Tailor the system to meet practice requirements
  • Establish a change-management process
  • Determine how to backload patient medical histories
  • Account for time your staff needs to learn and use the system
  • Support the system
  • Encourage your staff along the way


The downloadable guides in this section discuss how to implement an EHR, and they include supporting activities such as training, mock go-lives, and system testing.

Change Management in EHR Implementation

Change Management in EHR Implementation cover

Overview
Explains basic change-management principles and discusses the importance of managing change effectively during EHR implementation

Who it’s for
Providers and health IT implementers

When it’s used
To guide your process before and during EHR implementation

Download Change Management in EHR Implementation [PDF - 597 KB]

Chart Migration and Scanning Checklist

Chart Migration Checklist cover

Overview
Provides guidelines on what paper-record information you need to import into an EHR system

Who it’s for
EHR implementation lead, practice manager, and clinical lead

When it’s used
To plan EHR implementation; to conduct a paper-to-EHR migration

Download Chart Migration and Scanning Checklist [PDF - 597 KB]

Creating a Leadership Team for Successful EHR Implementation

Creating a Leadership Team for Successful EHR Implementation cover

Overview
Helps you create a leadership team and describes important roles and responsibilities; includes a template to use during your process

Who it’s for
Providers and health IT implementers

When it’s used
To consider implementing an EHR system

Download Creating a Leadership Team for Successful EHR Implementation [PDF - 487 KB]

Defining Goals and Objectives for EHR Implementation

Defining Goals and Objectives for EHR Implementation cover

Overview
Helps you establish realistic, measureable goals for your EHR implementation

Who it’s for
Providers and health IT implementers

When it’s used
To plan for and implement an EHR system

Download Defining Goals and Objectives for EHR Implementation [PDF - 628 KB]

It’s time to evaluate the implementation process and its effect on your practice. This is where you learn what worked — and what didn’t — so you can either avoid repeating mistakes or follow a similar path to success.

Issues to consider include:

  • Did your implementation process go smoothly?
  • Did everyone in your practice participate and feel involved?
  • Did events go as planned?
  • What were the implementation’s strengths and weaknesses?
  • Did the implementation affect workflow in your practice?
  • Can you identify opportunities for improvement?

You’ve met a significant milestone on your electronic health record (EHR) journey. A thorough evaluation provides a solid foundation, and it will help you continue to improve the value of your EHR system.

The downloadable tools in this section will help you use your EHR system functions to deliver quality care more efficiently. This section also includes a web-based tool: The C-CDA Scorecard.

Understanding C-CDA

C-CDA stands for Consolidated Clinical Document Architecture. It’s an industry standard that an EHR uses to exchange clinical information among providers and patients.

Different types of C-CDA documents include:

  • Consultation notes
  • Summary of care
  • History and physical
  • Discharge summary

C-CDA Scorecard

The C-CDA Scorecard is a web-based tool that lets providers quickly assess the quality and clarity of information in clinical documents — before reading the entire document.

  • A high score (greater than 90): means the document is formatted in such a way that it lets providers understand the clinical information accurately
  • A low score (less than 70): immediately tells providers that the document requires additional work before they can make sense of the information

Give this tool to your health IT implementer or support team. It will help you receive high-quality clinical information when working with the EHR vendors. If your EHR system earns a low score, work with your vendor or IT team to optimize performance.

Improving Care Coordination Using Consolidated Clinical Document Architecture (C-CDA) Scorecard

Overview
Lets you test the quality and clarity of information in clinical documents you receive during transition of care to improve care coordination

Who it’s for
Eligible professionals, eligible hospitals, and critical access hospitals (CAH)

When it’s used
To receive an electronic summary of care from a hospital or a referring provider during transition of care

Visit the Improving Care Coordination Using Consolidated Clinical Document Architecture (C-CDA) Scorecard website

Learning Guide: Driving Clinical Transformation in a Practice Setting with Health IT

Driving Clinical Transformation in a Practice Setting cover

Overview
Shows how you can use health IT to drive clinical transformation in your practice

Who it’s for
Individual practices, communities, and learning-collaborative organizers that want to use health IT to improve practice performance and care management

When it’s used
To teach stakeholders about the ways health IT can improve practice performance and care management

Download Learning Guide: Driving Clinical Transformation in a Practice Setting with Health IT [PDF - 382 KB]

Workflow Assessment for Health IT Toolkit

Overview
Helps you plan, design, implement, and use health IT in ambulatory care

Who it’s for
Providers, IT support staff, and practice managers

When it’s used
To find tips and guidance that address clinical and administrative workflow concerns

Visit the Workflow Assessment for Health IT Toolkit website

Workflow Redesign Templates for EHR Implementation

Workflow Redesign Templates for EHR Implementation cover

Overview
Provides guidelines for workflow process mapping to help you optimize EHR efficiency

Who it’s for
Providers, practice managers, and clinic staff

When it’s used
To plan your EHR implementation and throughout the entire process

Download Workflow Redesign Templates for EHR Implementation [PDF - 569 KB]

Migrating from paper-based documentation to an electronic health record (EHR) system requires careful planning, and so does migrating from one electronic environment to another. Reasons you may want to replace your EHR include:

  • Outgrowing your first EHR’s capabilities
  • Expanding your practice
  • Joining another practice

Careful data-migration planning ensures that your new EHR can both integrate and access historical data.

EHR Contract Guide Chapter 9: Transition Issues: Switching EHRs

EHR Contract Guide Chapter 9: Transition Issues: Switching EHRs cover

Download and follow the steps provided in Chapter 9 of the EHR Contract Guide to help you migrate data from your current EHR to your new EHR system.

Overview
Provides specific guidance for transitioning to a new EHR vendor, including:

  • Length of support
  • Data portability
  • Software license
  • Transition support services
  • Data transfer and conversion
  • Contract language and terms

Who it’s for
Providers, business and office managers

When it’s used
To transition to a new EHR system

Download EHR Contract Guide Chapter 9: Transition Issues: Switching EHRs [PDF - 117 KB]


Have a tool or resource to to make this Playbook even better? Share your feedback with us.

Section 1 Recap

Start the health IT journey by adopting electronic health records.

  • Understand EHR contracts
  • Select an EHR
  • Adopt and implement your EHR
  • Optimize your workflow
  • Migrate your data

Join the conversation.

Let us know how we can improve and expand on Electronic Health Records.

Content last updated on: May 31, 2017